TRENDS IN THE BURDEN OF ISCHEMIC HEART DISEASE AMONG PEOPLE LIVING WITH CHRONIC KIDNEY DISEASE IN ALBERTA

Introduction:

Ischemic heart disease (IHD), including ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI), is a major cause of death in individuals with chronic kidney disease (CKD). Although substantial advancements have been made in the treatment both IHD and CKD over the past several decades, data on the burden of IHD in the Canadian CKD population remain sparse.

Methods:

Using the Alberta Kidney Disease Network database, we created a cohort with CKD (aged ≥18 years) who were diagnosed with IHD between 2003 and 2019. CKD was defined based on standard methods. Case definitions for IHD, STEMI, and NSTEMI were determined using ICD-10 codes and obtained from hospital discharge records, physician billing claims, and ambulatory care classification system (ACCS) files. The date of IHD diagnosis was marked as either the date of inpatient hospital separation or the physician visit, depending on which occurred first. To assess trends in adjusted prevalence and incidence rates for the conditions of interest, we employed univariate least squares regression analysis and the negative binomial model. The rates were standardized by age group and sex using the 2011 Canadian population as a reference. The analysis was conducting using STATA 18.0, with a significance threshold set at p <0.05.

Results:

A total of 3,419,812 individuals were included in the cohort with mean age of 57.1 years and 43.8% were female. Of these, 91.3% had eGFR ≥60 ml/min/m2 and 8.3% had eGFR 30-59 ml/min/m2. The age- and sex- standardized prevalence of IHD increased across all stages of kidney function. Compared to patients with an eGFR ≥60 ml/min/m2, the rate of change in the prevalence of IHD was higher in patients with an eGFR 45-59 ml/min/m2, with an annual rate of change of 0.86 (95% CI: 0.66-1.05; test for interaction p <0.001). The incidence of STEMI decreased across all eGFR levels from 2003 to 2019, except for individuals with an eGFR 45-59 ml/min/m2, where incidence risk ratio (IRR) was 0.93 (95% CI: 0.87-1.00). Similarly, the incidence of NSTEMI decreased across all eGFR levels during the same period, except for individuals with an eGFR <15 ml/min/ m2, with an IRR of 0.96 (95% CI: 0.91-1.02) (Table 1).

Conclusions:

Between 2003 and 2019, the prevalence of IHD increased across all stages of CKD, while the incidence of acute forms of IHD (STEMI and NSTEMI) showed a decreasing trend. This may reflect improved longevity for individuals with IHD and CKD in Alberta during this period, likely due to advancement in their care. Future studies should evaluate the quality of care received by this population and its impact on adverse clinical outcomes, including hospitalizations, recurrent events, and mortality.  

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.